Maxillary Sinus Impaction of a Core Carrier Causing Sustained Apical Periodontitis, Sinusitis, and Nasal Stenosis: A 3-year Follow-up

Cerebral abscesses with odontogenic origin: a population-based cohort study

Objectives

Recent studies have indicated that cerebral abscess (CA) patients with odontogenic origin are on the rise. However, CA patients are often poorly characterized and with an unknown etiologic background. The purpose of this study is to identify and characterize CA patients that may have an odontogenic origin based on microbiologic, radiographic, and/or clinical findings.

Materials and methods

This is a population-based cohort study analyzing retrospective and prospective data from CA patients. Radiographic examinations of panoramic radiographs (PRs) or computed tomography (CT) scans were conducted. CA patients characterized with odontogenic origin required the fulfilment of the following criteria on admission: (1) Oral pathologic conditions were the only bacterial infections present, (2) oral microorganisms were isolated in the purulent exudate from the brain, and (3) radiographically and/or clinical recordings of oral pathologic conditions.

Results

A total of 44 patients could be included in this study of which 25 (57%) were characterized as having CA with a likely odontogenic origin. Type two diabetes (T2D) (p = 0.014) and microorganisms of the Streptococcus anginosus group (SAG) (p < 0.01) were overrepresented in patients with CAs of odontogenic origin.

Conclusions

Odontogenic infections may cause CAs to a greater extent than previously assumed. T2D was overrepresented among patients with odontogenic CA. When microorganisms of the SAG were isolated from the brain pus, CA patients had a predisposing odontogenic or sinus infection.

Clinical relevance

The identification of patients with a likely odontogenic CA will contribute to understanding the etiology of the infectious disease and highlighting the importance of preserving oral health.

An in vitro study on the effects of serum proteins on Enterococcus faecalis adhesion to three types of root sealers and gutta-percha

BACKGROUND

The extrusion of overfilled materials that extend beyond the apical foramina into the periradicular tissue may serve as a reservoir for bacterial adhesion and further affect recovery from periapical diseases. The aim of this study was to evaluate the effects of serum proteins on Enterococcus faecalis adhesion and survival on the surface of a calcium hydroxide-based root canal sealer (Apexit Plus), an epoxy resin sealer (AH-Plus) and a bioceramic sealer (iRoot SP).

METHODS

Apexit Plus, AH-Plus and iRoot SP were evenly coated on gutta-percha, using gutta-percha alone as the control. After root canal sealer setting, the number of E. faecalis adhering to the root canal sealers and gutta-percha was counted in fetal bovine serum (FBS) or tryptic soy broth supplemented with 1% glucose (TSBG) by viable cell plate counts. The morphology of 7-day-old E. faecalis biofilms in FSB and TSBG was observed by scanning electron microscopy (SEM). Furthermore, E. faecalis biofilms on the three root canal sealers were labeled with a LIVE/DEAD BacLight™ Bacterial Viability Kit, and the ratios of viable to dead cells were analyzed using laser scanning microscopy operative software (Zen software).

RESULTS

In the assays, after 1 and 7 days, the number of E. faecalis adhering to the root canal sealers or gutta-percha in FBS were significantly lower than those in TSBG (P < 0.05). In FBS, E. faecalis adhesion to iRoot SP and gutta-percha was reduced to a greater extent than that adhered to Apexit Plus and AH-Plus. Few E. faecalis accumulated on iRoot SP in FBS, whereas many bacteria assembled on iRoot SP and formed biofilms in TSBG. The ratio of viable cells in the E. faecalis biofilm on iRoot SP was the lowest.

CONCLUSIONS

Calcium hydroxide-based root canal sealers, epoxy resin sealers and bioceramic sealers may provide a substrate for E. faecalis adhesion, and the bioceramic sealer in this study showed the least E. faecalis adhesion in the presence of serum proteins compared to the other two sealers.

Retrospective evaluation of endodontic case reports published in the International Endodontic Journal and the Journal of Endodontics for their compliance with the PRICE 2020 guidelines

AIM

To evaluate, retrospectively, the quality of previously published case reports in Endodontics according to the PRICE 2020 guidelines.

METHODOLOGY

An electronic literature search was conducted in PubMed database on 12 March 2020, to identify case reports published during the last five years in the International Endodontic Journal and the Journal of Endodontics. For each of the included case reports, information regarding fulfilment of each of the items of the PRICE 2020 guidelines was extracted as '0' (not present in the manuscript), '1' (present in the manuscript) and 'NA' (not applicable) and translated into a score (percentage of items fulfilled). Additionally, the percentage of papers fulfilling each item was calculated.

RESULTS

Overall, 70 endodontic case reports were identified. The scores of the papers ranged between 56.41% and 79.55%, with a mean score of 70.26 ± 4.36% (SD). The percentage of papers fulfilling each item of the applicable PRICE 2020 items ranged widely, between 0% and 100%. The median of the percentage of all the items (n = 47) was 97.01% and mean 73.33 ± 36.28% (SD). The lowest scores were recorded for specific items in the following domains: 'Case Report Information'-Items 6c, 6g-i, 'Patient Perspective'-Item 8a and 'Quality of Images'-Items 12c-d.

CONCLUSIONS

Several areas with low reporting rates were identified in case reports published over the last 5 years in Endodontics. Authors should be encouraged to follow the PRICE 2020 guidelines in order to increase the quality and improve reproducibility of their case reports.

PRICE 2020 guidelines for reporting case reports in Endodontics: explanation and elaboration

Case reports play a key role in showcasing new, unusual or rare disease(s), and the impact of newer therapeutic approaches or interventions. The Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines are being introduced exclusively for Endodontics by adapting and integrating the CAse REport (CARE) guidelines and Clinical and Laboratory Images in Publications principles. The PRICE 2020 guidelines have been developed to help authors improve the completeness, accuracy and transparency of case reports in Endodontics and thus enhance the standard of manuscripts submitted for publication. The aim of this document is to provide a comprehensive explanation for each item in the PRICE 2020 checklist along with examples from the literature that demonstrate compliance with these guidelines. This information will highlight the importance of each item and provide practical examples to help authors understand the necessity of providing comprehensive information when preparing case reports. A link to this PRICE 2020 explanation and elaboration document is available on the Preferred Reporting Items for study Designs in Endodontology website at http://www.pride-endodonticguidelines.org.

Do in vitro solubility studies on endodontic sealers demonstrate a high level of evidence? A systematic review

OBJECTIVE

To systematically review the quality of evidence of available in vitro solubility studies on endodontic sealers according to prespecified evidence criteria.

MATERIAL AND METHODS

This systematic review was based on the PRISMA guidelines and the AMSTAR measurement tool. A systematic duplicate search of the literature on endodontic sealer solubility studies was conducted in PubMed and Embase databases (until 18 October 2017). Mapping terms to subject headings and free text terms were used and combined with hand searching before exclusion of duplicates. Studies specifically dealing with endodontic sealer solubility were selected. The evidence level was graded (low, medium or high) independently by two investigators following systematic data extraction in pilot forms, which was based on prespecified evidence criteria and the modified CONSORT checklist for in vitro studies on dental materials.

RESULTS

The search retrieved 1053 articles, from which 88 were assessed in full. From the 63 articles retained in the final analysis, 11 were classified as having moderate and 52 as low quality of evidence (0 high). The studies graded as low had low sample size (n < 10) and/or insufficient details to allow replicability. Most of the studies did not conform to the modified CONSORT checklist and did not include parameters considered relevant in the prespecified criteria.

CONCLUSIONS

Existing in vitro studies on the solubility of endodontic sealers do not demonstrate a high quality of evidence. Most of these studies do not present systematic reporting nor employ relevant parameters prespecified in our evidence criteria.

Shotgun sequencing of clinical biofilm following scanning electron microscopy identifies bacterial community composition

Bacterial biofilm infections often involve aggregates of bacteria heterogeneously distributed throughout a tissue or on a surface (such as an implanted medical device). Identification of a biofilm infection requires direct visualization via microscopy, followed by characterization of the microbial community by culturing or sequencing-based approaches. A sample, therefore, must be divided prior to analysis, often leading to inconsistent results. We demonstrate a combined approach, using scanning electron microscopy and next-generation shotgun sequencing, to visually identify a biofilm and characterize the microbial community, without dividing the sample. A clinical sample recovered from a patient following a dental root-filling procedure was prepared and visualized by scanning electron microscopy. DNA was then extracted from the sample several years later and analyzed by shotgun sequencing. The method was subsequently validated on in vitro cultures of Pseudomonas aeruginosa biofilm. Between 19 and 21 different genera and species were identified in the clinical sample with an estimated relative abundance greater than 1% by two different estimation approaches. Only eight genera identified were not associated with endodontic infections. This provides a proof-of-concept for a dual, microscopy and sequencing-based approach to identify and characterize bacterial biofilms, which could also easily be implemented in other scientific fields.

UV light assisted antibiotics for eradication of in vitro biofilms

The overuse of antibiotics is accelerating the bacterial resistance, and therefore there is a need to reduce the amount of antibiotics used for treatment. Here, we demonstrate in vitro that specific wavelengths in a narrow range around 296 nm are able to eradicate bacteria in the biofilm state (grown for 24 hours) more effectively, than antibiotics and the combination of irradiation and antibiotics is even better, introducing a novel concept light assisted antibiotics. The investigated wavelength range was 249 nm to 338 nm with an approximate step of 5 nm. The novel concept that consists of a UV irradiation treatment followed by a tobramycin treatment can significantly reduce the amount of antibiotics needed for eradicating mature bacterial biofilms. The efficiency of the proposed light assisted antibiotics method was compared to combinatory antibiotic treatment and highly concentrated antibiotic monotherapy. The eradication efficacies, on mature biofilms, achieved by light assisted antibiotic and by the antibiotic monotherapy at approximately 10-fold higher concentration, were equivalent. The present achievement could motivate the development of light assisted antibiotic treatments for treating infections.